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Adjunctive bacteriophage therapy for prosthetic valve endocarditis due to Staphylococcus aureus

Timothy Gilbey, Josephine Ho, Louise A Cooley, Aleksandra Petrovic Fabijan and Jonathan R Iredell
Med J Aust 2019; 211 (3): . || doi: 10.5694/mja2.50274
Published online: 5 August 2019

To the Editor: Infective endocarditis with Staphylococcus aureus is associated with a high mortality despite optimal antibiotic therapy.1 The synergy between bacteriophages and antibiotics has been shown in vitro and in animal studies,2 and bacteriophages have demonstrated their value in severe bacterial infections.3 AB‐SA01 (AmpliPhi Biosciences) is a bacterial DNA‐free and protein‐free highly purified preparation of three obligately lytic Myoviridae, each at 109 plaque‐forming units per dose.4 This preparation has been recently used successfully for staphylococcal sinusitis by local irrigation.5 A protocol was established for bacteriophage therapy as an adjunct to standard care of severe staphylococcal infections under the auspices of the Therapeutic Goods Administration Special Access Scheme. Here, we report the first intravenous use of AB‐SA01 in a case of severe staphylococcal sepsis with prosthetic valve endocarditis.


  • 1 Westmead Hospital, Sydney, NSW.
  • 2 Westmead Institute for Medical Research, Sydney, NSW.
  • 3 Royal Hobart Hospital, Hobart, TAS.
  • 4 University of Sydney, Sydney, NSW.



Acknowledgements: 

This manuscript was prepared in collaboration with the Westmead Bacteriophage Therapy Team (WBTT) and AmpliPhi BioSciences. We thank Patricia Fa for pharmacy support, Ruby Lin (WBTT project manager and scientific lead) for project support, and Belinda Dillon‐Roychoudhry for technical assistance.

Competing interests:

No relevant disclosures.

  • 1. Asgeirsson H, Thalme A, Weiland O. Staphylococcus aureus bacteraemia and endocarditis — epidemiology and outcome: a review. Infect Dis (Lond) 2018; 50: 175–192.
  • 2. Oechslin F, Piccardi P, Mancini S, et al. Synergistic interaction between phage therapy and antibiotics clears Pseudomonas aeruginosa infection in endocarditis and reduces virulence. J Infect Dis 2017; 215: 703–712.
  • 3. Rohde C, Wittmann J, Kutter E. Bacteriophages: a therapy concept against multi‐drug‐resistant bacteria. Surg Infect (Larchmt) 2018; 19: 737–744.
  • 4. Lehman SM, Mearns G, Rankin D, et al. Design and preclinical development of a phage product for the treatment of antibiotic‐resistant Staphylococcus aureus infections. Viruses 2019; 11: 88.
  • 5. Drilling AJ, Ooi ML, Milikovic D, et al. Long‐term safety of topical bacteriophage application to the frontal sinus region. Front Cell Infect Microbiol 2017; 7: 49.

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